Money, Politics and the Decline of American Health

It may seem odd to sug­gest that lob­by­ing, and in par­tic­u­lar Citizens United, the Supreme Court deci­sion that per­son­i­fies cor­po­ra­tions and allows unlim­ited cor­po­rate cam­paign con­tri­bu­tions through polit­i­cal action com­mit­tees, threat­ens our nation’s health. But it does.

If money rules pol­i­tics, then our nation is not pro­tected from disease-causing Frankenfoods includ­ing soda and processed foods, or from unre­stricted mar­ket­ing of the lowest-quality, sugar-laden foods to our chil­dren. When money rules pol­i­tics, our agri­cul­tural lands, soils and aquifers are depleted through oil-dependent indus­trial farm­ing sup­ported by bil­lions in fed­eral subsidies.

Depleting Nature’s and Human Capital

We are deplet­ing nature’s capital—capital that once destroyed, can­not be reclaimed. One acre of arable land is lost to devel­op­ment every minute of every day. One pound of meat requires 2,000 gal­lons of water and pro­duces 58 times more green­house gases than 1 pound of pota­toes. It takes 7,000 pounds of grain to pro­duce 1,000 pounds of meat. Irrigation is deplet­ing our Ogallala Aquifer on the Great Plains 1.3 tril­lion gal­lons faster than it can be replen­ished by rain­fall. Three-quarters of our fresh water (only 5 per­cent of all the earth’s water) is used for agri­cul­ture, mostly to grow meat for human consumption.

If we all switched out one meat meal for a veg­e­tar­ian meal each week, it would be the equiv­a­lent of tak­ing half a mil­lion cars off the road. Driving a Hummer and being a veg­e­tar­ian pro­duces less green­house gases than dri­ving a Prius and eat­ing fac­tory farmed meat. Yet when the USDA (United States Department of Agriculture) encour­aged us to par­tic­i­pate in “Meatless Mondays,” the National Cattleman’s Beef Association lob­bied the gov­ern­ment to retract their rec­om­men­da­tion. And they did. Money in politics.

During health reform, I men­tioned to Senator Harkin that all we wanted was for sci­ence to become pol­icy. With a wry and some­what sad smile he said, “That would be nice.”

Our energy poli­cies sup­port Orwellian “clean coal” that still dis­charges mer­cury, lead and par­tic­u­late mat­ter into our air, pro­mot­ing heart dis­ease, can­cer and more, and our polit­i­cally hand­i­capped Environmental Protection Agency allows envi­ron­men­tal poli­cies that per­mit untested chem­i­cals and tox­ins to per­me­ate our lives. Should we worry when the aver­age new­born has 287 known tox­ins in his or her umbil­i­cal cord blood that have been linked to neu­rode­vel­op­ment dis­or­ders such as atten­tion deficit dis­or­der and autism that now affects 1 in 6 of our nation’s chil­dren? What are the social and eco­nomic costs of that?

The rea­son we have these poli­cies is not that they were encour­aged and sup­ported by cit­i­zens through a demo­c­ra­tic process or grass­roots move­ment. The poli­cies are there for one reason—they were encour­aged, shaped, lob­bied for and even often ghost­writ­ten by indus­tries whose sole focus is profit, not pub­lic welfare.

Money in Health Care: Perverse Incentives

If money rules pol­i­tics, then the most prof­itable med­ical ther­a­pies, not the best treat­ments, are researched and imple­mented. If hos­pi­tals and doc­tors are paid for vol­ume and piece­work, they pro­duce more vis­its and pro­ce­dures, but not bet­ter health. If hos­pi­tals sud­denly cut car­diac bypasses and angio­plas­ties in half by imple­ment­ing proven inten­sive lifestyle ther­a­pies, they would go bank­rupt. If Medicare refused to reim­burse for car­diac bypasses or angio­plas­ties proven to work in less than 5 per­cent of patients that receive them, and instead reim­bursed for inten­sive lifestyle treat­ment pro­grams for those with heart dis­ease and dia­betes, health care costs, as esti­mated by the Cleveland Clinic, would be reduced by almost one tril­lion dol­lars over the next 10 years. But since lifestyle treat­ment is not reim­bursed it is not prof­itable, so it is not done.

At a recent med­ical inno­va­tion con­fer­ence, I met with the head of Walgreen’s new Take Care Clinic and was impressed with their focus on edu­ca­tion and ser­vice. But when I asked if he would imple­ment a pro­gram that could be deliv­ered through their clin­ics that could reduce pre­scrip­tion med­ica­tion use by half, he was not inter­ested. They want to appear to do the right thing, but not do it.

The head of health infor­ma­tion tech­nol­ogy from Partner’s Health Care, the Harvard group of hos­pi­tals, shared at a med­ical admin­is­tra­tors meet­ing that the head of the Harvard health sys­tem rejected a pro­posal to con­nect two hos­pi­tals by a data line that would save 15 per­cent in labs costs by reduc­ing redun­dant lab tests. They couldn’t afford a 15 per­cent reduc­tion in lab billing.

Perverse eco­nomic incen­tives drive pol­icy and med­ical deci­sions, not the best inter­ests of the patients, and cer­tainly not bet­ter health out­comes. Violation of pub­lic trust, the sacred covenant between our elected lead­ers and our peo­ple, results from money in pol­i­tics. What ever hap­pened to gov­ern­ment by the peo­ple, for the peo­ple and of the peo­ple? My friend, lawyer and envi­ron­men­tal advo­cate Robert F. Kennedy, Jr., calls our polit­i­cal sys­tem a “cor­po­rate klep­toc­racy.” Communism, he says, is when the gov­ern­ment runs busi­ness; and fas­cism is when busi­ness runs government.

Our nation’s health and econ­omy are close to enter­ing an irrev­o­ca­ble down­ward spi­ral. It is dif­fi­cult for most of us to grasp the immen­sity of the polit­i­cally sanc­tioned eco­nomic forces at work that threaten our health. This quiet, dan­ger­ous set of forces in play in American soci­ety fuel the explo­sive and uncon­trolled growth of dis­ease in America.

Accounting for Sustainability: The True Cost of Money in Politics

The basic fact is that one-third of our econ­omy prof­its from mak­ing peo­ple sick and fat. The food indus­try sells prod­ucts sci­en­tif­i­cally proven to kill more peo­ple than cig­a­rettes, while our health care indus­try prof­its from pro­vid­ing more vol­ume of care focused on med­ica­tion and pro­ce­dures, not bet­ter health.

Certain facts are clear. Lifestyle-induced chronic dis­ease is on the rise, and accounts for nearly 80 per­cent of our health care costs. Nearly 70 per­cent of our pop­u­la­tion is over­weight or obese. Almost 1 in 4 teenagers have pre-diabetes or Type 2 dia­betes, up from only 9 per­cent in 2000 and almost zero in 1960. Most chronic dis­ease is best pre­vented and even treated with lifestyle med­i­cine and a sys­tems approach to dis­ease. By 2042, 100 per­cent of our fed­eral bud­get will be needed to pay for Medicare and Medicaid. Today, 1 in 3 Medicare dol­lars is spent on Type 2 dia­betes. This is unsustainable.

The true cost of our food and agri­cul­ture, energy, edu­ca­tion, envi­ron­men­tal poli­cies on our health are not even mea­sured in the equa­tion. Our gov­ern­ment sub­si­dizes the pro­duc­tion of low-cost high-fructose corn syrup and trans fats from soy­beans (used to make soda and French fries), but we don’t do an accu­rate cost account­ing of the health, envi­ron­men­tal and energy impact of pro­duc­ing those crops in the way we do, or the health impact on the chil­dren and adults who con­sume those products.

Prince Charles gave a speech at the Future of Food con­fer­ence at Georgetown University in 2011. He describes a new kind of cost account­ing, “account­ing for sus­tain­abil­ity” that expands our account­ing processes to include the inter­con­nected impact of finan­cial, health, envi­ron­men­tal and social impact on long-term “profits.”

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